Physical inactivity Physical inactivity contributes to overweight and obesity, cardiovascular disease, malignancies, diabetes, and many other adverse medical conditions. Participating in a regular physical exercise routine can increase insulin sensitivity, improve lipid levels, reduce blood pressure, reduce weight, lower the risk of cardiovascular disease, and improve blood glucose management in type 2 diabetes (Ignatavicius et al., 2018). Smoking Smoking is a significant risk factor for the development of type 2 diabetes and makes the disease harder to control after its development. Smokers are 30% to 40% more likely to develop type 2 diabetes than nonsmokers. People who smoke are more likely than nonsmokers to have trouble managing the disease Such medications as glucocorticoids, thiazide diuretics, and atypical antipsychotics increase the risk of diabetes (American Diabetes Association, 2021b). Healthcare Professional Consideration: Healthcare professionals need to be aware of the significance of metabolic syndrome. Metabolic syndrome is a group of conditions (hypertension, elevated blood glucose levels, excess amounts of body fat around the waist, and abnormal cholesterol level) that exist in conjunction with one another and increase the risk of cardiac disease, stroke, and diabetes. Taking steps to alter the impact of modifiable risk factors for diabetes can delay or possibly prevent the occurrence of serious health conditions (Mayo Clinic, 2020a). Assessing diabetic patients should include indicators for metabolic syndrome. Cholesterol level and blood pressure should be monitored at least yearly for obese patients at risk of diabetes. Self-Assessment Quiz Question #4 When counseling patients about modifiable risk factors for diabetes, it is important to explain that: a. A person is considered overweight of the BMI is 18.5 to <25. b. Adults should engage in 60 minutes of moderate-intensity aerobic activity every week. c. The desired HDL is less than 150 mg/dL. d. Smokers are 30% to 40% more likely to develop type 2 diabetes than non-smokers. (CDC, 2021e). Medications
○ Seventy-five minutes of vigorous-intensity aerobic activity every week and muscle strengthening activities that work all major muscle groups two or more days a week. Moderate-intensity aerobic activity is defined as exercising hard enough to increase heart rate and break a sweat. Examples include walking fast, water aerobics, riding a bicycle on level ground, and pushing a lawn mower. Vigorous-intensity aerobic activity is defined as exercising hard enough to breathe hard and fast and increase heart rate significantly. Examples include jogging, running, swimming laps, riding a bicycle rapidly or on hills, and playing basketball. Physical activity can be spread out so that it is not done all at once. However, physical activity should be sustained for at least 10 minutes at a time (American Heart Association, 2021; CDC, 2021b). Elevated blood glucose An elevated blood glucose level significantly increases the risk of diabetes as well as for cardiovascular disease and stroke. The American Diabetes Association recommends using one of three testing methods (American Diabetes Association, 2021b; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2018e): 1. A1C test 2. Fasting plasma glucose (FPG) 3. Oral glucose tolerance test (OGTT) Hypertension Hypertension is a modifiable risk factor for diabetes as well as for cardiovascular disease and stroke. Hypertension is defined as a consistent systolic pressure of 130 mmHg or higher or diastolic pressure of 80 mmHg or higher. For persons who do not have diabetes, blood pressure should be evaluated at each regular health care provider visit or at least once every two years if it is less than 120/80 mmHg. For patients who have diabetes, blood pressure should be measured at each regular health care provider visit or as often as needed (CDC, 2020b; Ignatavicius et al., 2018). Abnormal lipid metabolism Abnormalities in cholesterol levels can contribute not only to cardiovascular disease but also to the development of diabetes mellitus. The desired goals of cholesterol levels for adults are as follows (Mayo Clinic, 2021a): ● LDL: below 70 mg/dL for people who have heart disease or diabetes; below 100 mg/dL for people at risk of heart disease; and 100 to 129 mg/dL near optimal if there is no heart disease but high if there is heart disease. ● HDL: greater than 60 mg/dL ● Triglycerides: less than 150 mg/dL ● Total cholesterol: less than 200 mg/dL Many of the signs and symptoms of type 1 and type 2 diabetes are the same. There are, however, some differences. It is important for healthcare professionals to recognize all clinical manifestations Clinical manifestations of type 1 diabetes mellitus Type 1 diabetes is found most often in children. But the disease can also develop in adults. Patients with type 1 diabetes generally report an abrupt onset of symptoms. Following are the classic symptoms of type 1 diabetes (Khardori, 2021a; 2021b): ● Polyuria: production of abnormally large amounts of urine that is dilute ● Polydipsia: abnormally great thirst ● Polyphagia: excessive appetite or excessive feelings of hunger ● Unexplained weight loss Polyuria is caused by osmotic diuresis secondary to hyperglycemia. Severe nocturnal enuresis (bedwetting) secondary to polyuria suggests type 1 diabetes in young children. Polyphagia develops to dehydration and hyperosmolar status (Khardori, 2021a; 2021b). Following are other clinical manifestations of type 1 diabetes mellitus (Khardori, 2021a; 2021b): ● Weight loss occurs despite experiencing excessive appetite and hunger. This is caused by water depletion and a
PRESENTING CLINICAL SIGNS AND SYMPTOMS OF DIABETES MELLITUS
of the disease and to know which of those signs and symptoms are more prevalent in one of the two types.
catabolic state with reduction in glycogen, proteins, and triglycerides. ● Fatigue and weakness may occur secondary to muscle wasting caused by a catabolic state of insulin deficiency, hypovolemia, and hypokalemia. ● Muscle cramping is caused by electrolyte imbalance. ● Blurred vision is a result of osmotic swelling of the lens, which alters its normal focal length. Type 1 diabetes may also cause gastrointestinal (GI) disturbances (Khardori, 2021a; 2021b): ● Nausea, abdominal pain, and changes in bowel movements: these signs and symptoms may accompany acute diabetic ketoacidosis. ● Right upper quadrant pain because of acute fatty liver. ● Persistent GI disturbances, which may be caused by abdominal causes of diabetic ketoacidosis. The onset of symptomatic type 1 diabetes may be abrupt. The first evidence of the disease may be the occurrence of ketoacidosis (Khardori, 2021a; 2021b).
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